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Musculoskeletal Occlusal Signs and Symptoms

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Musculoskeletal Occlusal Signs and Symptoms

Today in dentistry, there are numerous musculoskeletal occlusal signs and symptoms that can alert the clinician to other related problems that often go unrecognized during a routine dental examination. An comprehensive dental examination should include an evaluation of all the masticatory muscles including the intra-oral muscles, the extra-oral muscles, the cervical neck and shoulder muscles.  These muscles are designed to assist an unhindered movement of the lower jaw (the mandible) to move laterally with no pain, protrusively with no pain, restrusively with no pain and vertically open with no pain.  If there is pain or tenderness during these movements it would be an indicator that something is wrong.

All movements of the mandible should support an ergonomic functional and esthetic balance between the teeth (occlusion) without chipping, torquing, and extraneous straining to the periodontium that contribute to excessive gum recession and bone degradation.

Symptoms:

There is increasing evidence that indicates that abnormal mandibular jaw closure patterns contributes to:

These type of symptoms are signs of temporomandibular joint dysfunction (TMJ/TMD) which are a common problem among 10 million people in the USA.  Approximately 1 in 27 or 3.68% of all people in USA experience these types of symptoms daily. <National Institute for Dental and Craniofacial Research>.

Extra Oral Signs and Symptoms:

  • Facial asymmetry (bilaterally)
  • Short lower third of face
  • Deep mentalis crease
  • Abnormal lip posture
  • Chelitis
  • Dished out or flat labial profile
  • Retrusive upper lip
  • Facial edema
  • Mandibular torticollis
  • Forward head posture (lordosis)
  • Elongated lower face (Steep mandibular angle)
  • Speech abnormalities

Intra Oral Signs and Symptoms:

It is these abnormal jaw closure patterns that contribute to:

  • Crowded lower anterior teeth
  • Abnormal anterior teeth wear patterns
  • Lingually inclined lower anterior teeth
  • Lingually inclined upper anterior teeth (Div. 2 occlusion)
  • Lower bicuspids lower than anterior incisors
  • Lingually tipped posterior teeth
  • Narrow mandibular arch
  • Narrow maxillary arch (High palatal vault)
  • Flaired upper anterior teeth
  • Tooth mobility
  • Excessive mandibular incisal wear of the lower anterior teeth
  • Bicuspid abfractions (cervical erosion)
  • Wear facets on bicuspids and canines
  • Chipped/fractured anterior teeth
  • Loss of molars
  • Open interproximal contact (spaces)
  • Unexplained gingival inflammation
  • Cross bites
  • Anterior open bites
  • Anterior tongue thrust
  • Lateral tongue thrust
  • Scalloping of lateral border of the tongue

Deep bites may also be indicative of an entrapped mandible that may function more anterior than the existing maximal intercuspal position during speech, swallowing and chewing patterns.

  • Is it possible that the dentist has overlooked the fact that the jaws may be posteriorized and lack adequate posterior occlusal height (posterior vertical deficiency) that can contribute to ear congestion feelings, jaw joint tenderness, clicking and popping joints, where the condyles are posterior and superiorly positioned within the joint fossa causing the articular disc to anteriorize?
  • This condition is called hypo-occlusion of the posterior teeth.

Excessive worn dentition, root exposure over time with accompanying gingival recession may develop even though the patient may be under carefully managed oral hygiene care and maintenance.  These are all low grade signs, occlusal indicators and symptoms of TMJ/TMD.

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